内镜黏膜剥离术治疗早期胃癌的效果及对胃蛋白酶原水平的影响

Effect of endoscopic submucosal dissection on early gastric cancer and its influence on pepsinogen level

目的分析内镜黏膜剥离术(ESD)治疗早期胃癌的效果及对胃蛋白酶原水平的影响。方法抽取2018年5月至2020年6月信阳市人民医院收治的早期胃癌患者184例,按照手术方案分为两组,每组92例。采用内镜黏膜下切除术(EMR)为EMR组,采用ESD为ESD组。比较两组组织学效果、围术期情况、视觉模拟评分法(VAS)评分、胃蛋白酶原(PG)中PGⅠ、PGⅡ、PGⅠ/PGⅡ水平,比较两组血清肿瘤标志物[糖类抗原199(CA199)、血管内皮生长因子(VEGF)]水平、并发症发生率、复发率。结果ESD组整体切除率(95.65%,88/92)、治愈性切除率(88.04%,81/92)高于EMR组(82.61%,76/92;70.65%,5/92),差异有统计学意义(P<0.05)。与EMR组比较,ESD组手术时间长,但术中出血量少、术后排气时间和恢复进食时间短(P<0.05)。术后6、12、24 h,ESD组VAS评分低于EMR组(P<0.05);术后7 d,ESD组PGⅠ、PGⅠ/PGⅡ水平高于EMR组,PGⅡ、CA19-9、VEGF水平低于EMR组(P<0.05)。ESD组总并发症发生率(4.35%,4/92)低于EMR组(13.04%,12/92),ESD组复发率(1.11%,1/90)低于EMR组(10.11%,9/89),差异均有统计学意义(P均<0.05)。结论ESD治疗早期胃癌可提高组织学效果,降低血清肿瘤标志物水平,调节PG表达,促进胃肠功能和术后机体恢复,具有手术安全性,并可降低复发风险。

Objective To analyze the clinical effect of endoscopic mucosal dissection(ESD)on early gastric cancer and its influence on pepsinogen level.Methods A total of 184 patients with early gastric cancer who were admitted to Xinyang People’s Hospital from May 2018 to June 2020 were selected,and the patients were divided into two groups according to the operation plans,with 92 cases in each grap.The patients who underwent endoscopic submucosal resection(EMR)were assigned to the EMR group,and 92 patients who underwent ESD were assigned to the ESD group.The histological effects,perioperative conditions,visual analogue scale(VAS)scores,levels of pepsinogen(PG)including PGⅠ,PGⅡ,and PGⅠ/PGⅡ,and serum tumor markers,such as carbohydrate antigen 199(CA199)and vascular endothelial growth factor(VEGF)levels,complication rate,and recurrence rate were compared between the two groups.Results The overall resection rate(95.65%,88/92)and the curative resection rate(88.04%,81/92)of the ESD group were higher than those of the EMR group(82.61%,76/92;70.65%,5/92),and the differences were significant(P<0.05).Compared with the EMR group,the ESD group had a longer operation time,but less intraoperative blood loss,shorter postoperative exhaust time,and shorter time to resume eating(P<0.05).At 6,12,and 24 hours after operation,the VAS score of the ESD group was lower than that of the EMR group(P<0.05).On the 7th day after operation,the levels of PGⅠand PGⅠ/PGⅡin the ESD group were higher than those in the EMR group,and the levels of PGⅡ,CA19-9 and VEGF in the ESD group were lower than those in the EMR group(P<0.05).The total complication rate in the ESD group(4.35%,4/92)was lower than that in the EMR group(13.04%,12/92),while the recurrence rate of the ESD group(1.11%,1/90)was lower than that in the EMR group(10.11%,9/89),and the differences were all significant(all P<0.05).Conclusions ESD in the treatment of early gastric cancer can improve the histological effect,reduce the level of serum tumor markers,regulate the expression of PG,and promote gastrointestinal function and postoperative recovery.It is safe,and can reduce the risk of recurrence.